Provider Demographics
NPI:1285471441
Name:LONG, ELIZABETH S (DNP, ARNP, FNP-C)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:S
Last Name:LONG
Suffix:
Gender:F
Credentials:DNP, ARNP, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 BROADWAY STE 100
Mailing Address - Street 2:PMB 100080
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98402-3900
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:401 BROADWAY STE 100
Practice Address - Street 2:PMB 100080
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402-3900
Practice Address - Country:US
Practice Address - Phone:425-777-5467
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-13
Last Update Date:2024-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61561436363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily